Post-Traumatic Stress Disorder and Hope
10.16.2019 Written by: Henningson & Snoxell, Ltd.
Is there hope for those who have been diagnosed with post-traumatic stress disorder? Today I had the pleasure of attending HealthPartners Occupational Medicine Department‘s special guest lecture given by Dr. Charl Els, a psychiatrist, addiction specialist and occupational physician Clinic Professor at the Department of Psychiatry at the University of Alberta, entitled “Nietzche Was Right: Revising What Happens after Exposure to Trauma.”
Dr. Els explained the mechanisms of developing PTSD. After exposure to trauma, or a Criteria A event, some people develop a psychopathology known as post-traumatic stress disorder. In the Minnesota Workers’ Compensation system, we define PTSD by the DSM-V, the most recent diagnostic statistical manual for mental disorders.
Dr. Els noted that while many people are exposed to Criteria A events, approximately 8 – 9% develop “full blown PTSD.” He further noted that some people are predisposed to developing PTSD, and this predisposition may result from a combination of genetics and/or chronic repeated exposure to childhood trauma. Dr. Els cautioned that in legal settings, we do not rely on the “but for” test. In Canada courts look to the “material cause” of the psychiatric disorder. Under the Minnesota Workers’ Compensation Act, courts use the “substantial contributing cause or factor” test, meaning that the traumatic exposure(s) does not have to be the only cause but a substantial contributing cause or factor to the condition.
Dr. Els explored some of the difficulties in diagnosing PTSD, primarily that physicians do not have an objective diagnostic system for mental illness, diagnosing mental illness is inherently subjective. He recommended psychometric testing in conjunction with medical provider evaluations, to ensure diagnostic validity. He recommended MFAST, SIMS, MMPI, MCMI, PAI, and DAPS testing from a licensed administrator. Dr. Els cautioned that testing is not done in a vacuum, that these are tools and should not be used in isolation.
Dr. Els highlighted psychological resiliency as a tool to combat PTSD. He concluded, based on studies that examined those who suffer from PTSD, that there is hope. The studies found that people exposed to severe trauma may experience positive change and experience PTG or “post-traumatic growth.” These individuals developed psychological resiliency, after treatment and care, and went on to not only return to baseline functioning but to a level of functioning that was better than before. He did not minimize their experience, trauma or suffering, but rather emphasized the notion that suffering does not need to debilitate a person permanently.
In my practice as a workers’ compensation and personal injury attorney for police officers, firefighters, and first responders, when clients first meet with me, they are anxious, depressed, and barely able to hold it together. These men and women are exhausted from putting on a front of “I’m fine, I’m okay,” to their partners, colleagues, and families. They feel like they just can’t do it anymore and they need help. They are not functional and certainly should not be working in a first responder capacity, where split second decisions mean the difference between life and death for themselves, their partners, and the public.
Unfortunately, many first responders don’t seek treatment for fear of losing their job, of being deemed unstable or unfit for duty, as well as the stigma of seeking treatment for mental illness. They are afraid to seek professional help until they know their legal options. They know that if the department finds out they are suffering from PTSD, they will be put on administrative leave but that the city or the county will not willingly admit that they have work-related PTSD and will look for an opportunity to deny their claim. The employers and insurers force these first responders in an impossible dilemma: go get help but it’s not our fault, so we won’t help you. After my clients get help from therapists, psychologists, and psychiatrists, they do get better. The results are visible on their faces. The same police officer, firefighter, or paramedic who walked into my office 9 months ago is a different person. They are lighter and free from the weight of hiding their struggles. The transformation is incredible and a reminder of why I do what I do.
Dr. Els is right, there is so much hope.
Mary Beth Boyce is a tenacious trial attorney who has successfully represented clients through jury trials and argued in front of the Workers’ Compensation Court of Appeals, Minnesota Court of Appeals, and Minnesota Supreme Court. She is a strong advocate in the mediation and negotiation process and is a member in good standing with the Minnesota State Bar Association and the Minnesota Association for Justice.